Question about insurance- medicaid coverage for speech therapy?

[Guest guest]

Hi All!

Does anyone else on here have experience dealing with medicaid for

therapies?

I am a self- employed single parent and my son recieves straight

medicaid through being adopted from foster care.

I am being told by his new speech therapist that medicaid will only

cover 8 30 min sessions a month (30 min 2X wk) regardless of how far

behind the child is. She also told me that my son is by far the most

severe case of apraxia she has ever seen.

Has anyone else been in my shoes?

Have any suggestions?

I would like to get the most I can out of insurance and am not sure

if this really is it???

He is in SN pre-k and I am meeting with his Speech therapist he is

seeing there this friday. Currently the school is only providing him

1 30min individual session and 1 group session with 3 other children

that all can talk. My son can say 'Hi' and about 15 approxmations

that only people that know him can understand. He turned 3 the

beginning of January and has been recieving EI speech since he was 17

months old. I am going to insist that he get individual ST sessions.

I think he should get it every day at the school but at least 3 times

a week. Is this too much to expect from the school system?

I have a very limited income and another child I am trying to get EI

speech for also. I want to start private ST with someone that

specializes in apraxia but it is very expensive and I am saving so I

can afford 3 months worth before I start so he wont have to keep

missing.

I am so overwhelmed by all this red tape to get my son the help he

needs. So much time has went by with very very little progress and I

worry he may never have his voice if I cant hurry and get him the

help he needs.

[Guest guest]

Not sure if this helps:

Re: Just found out that Speech Therapy is not covered

Dear Sara,

Do you know for 'sure' that speech therapy is not covered by state

funded health care? What about oral motor therapy? Say your child

has trouble eating or drinking- is therapy for that covered? Play

the game -find out what type of speech therapy is covered by the

state and I'm sure if your child is apraxic you can get coded for

that. Apraxia is rarly 'just' a motor planning issue as many also

have tonal issues, weakness, sensory issues that overlap. Also don't

take no for an answer so quick. Most do -but insurance companies

count on the fact that only 10% will fight a " no " They may say " no "

again -and again only 10% will fight that second no. By the third

fight however you are not probably working with someone who has a

clue -and since you are at this point 10% of 10% (of 10%) you'll

probably get a yes.

Besides I just quickly did a search at Google and I found that speech

therapy is covered by most state funded health care. Here's a few

quotes from one of the sites:

http://www2.doh.wa.gov/HWS/doc/MCH/MCH_CSN2004.doc

" Children in special education programs are eligible for educational

services from ages 3 to 21, including nursing care, physical therapy,

speech therapy, occupational therapy, and special education.

According to the National Survey of CSHCN, about 32% of Washington's

children with special needs in this age group were enrolled in

special education programs, including more than half of children with

special needs identified as having functional limitations. Data from

a 1997 survey of school nurses in Washington showed that all school

districts in the state serve at least one child with a chronic

illness.13 Nationally, children with special health care needs

experience three times as many school absences as other children.7

These absences affect the child's educational progress and may also

interrupt school-based therapies and services that promote the

child's overall well being. "

" Low income. Accessing health care is more difficult for families

with low incomes. Among other issues, these families face problems

with transportation, difficulty maintaining continuity of providers,

and the unwillingness of providers to include in their practice

clients who are uninsured or enrolled in Medicaid.15 In the 2002

Washington State Medicaid Client Satisfaction Survey, families with

children with special needs were statistically more likely to report

problems getting care, medications, occupational, physical or speech

therapy, and referral to a specialist than families without children

with special needs.16 "

16 " Washington State Medical Assistance Administration, Consumer

Assessment of Health Plans, 2002 "

Fight for your child's rights - because we know if you don't your

child's SLP won't either. (Time for a new one even if you could

afford her!) Anyone else here from Washington State to help? Here's

some of the support sources I found at Speechville:

Support Contacts*:

Contact: Crystal

Longview - Kelso area, Washington

E-Mail: scmartin@...

Contact:

Auburn, Tacoma, Seattle Washington

E-Mail: rjgsmith@...

Contact: bel Cowley

Seattle, Washington

E-Mail: belCowley@...

Phone: (206) 675-0713

Things to do at home -yes answers for that too!

The below link is a parent geared article I wrote for Contemporary

Pediatrics; the trade magazine for pediatric medical professionals

nationwide. The article is mainly pulled from The Late Talker book

which I co authored with neurodevelopmental pediatrician Dr. Marilyn

Agin, and International Journalist Malcolm Nicholl on things you can

do to help stimulate speech in your late talker child at home:

http://www.contemporarypediatrics.com/contpeds/data/articlestandard/contpeds/492\

004/136315/article.pdf

Actually in many ways The Late Talker may be a help to you.

Not in that article above -but Rhonda who was one of the founders of

the nonprofit ECHO of Canada has said that the Kaufman Kit made her

at that time her daughter's best SLP when there were no SLPs around

that were aware of how to best help an apraxic child in her area of

Canada...and she's not the first to say that. You can look for a

used one -or at times people here have donated their old Kaufman Kits

to moms like you in need (so head's up to someone who's child is

doing well and you want to donate that kit to pay it forward!)

Below are some archives on ways to secure inexpensive or free therapy

services:

Thu Jun 6, 2002 3:43 pm

" kiddietalk " kiddietalk@...

Re: College and ish Rite schools

Hi Marsha!

I'm not sure about a list of ish Rite schools -however, here are

some links for Universities that have programs in Speech Language

Pathology and Audiology. Contact the Universities located in your

area and ask if they offer speech therapy services to the public. I

believe all therapy is done by graduating students and is overseen by

a PhD. They typically will provide therapy at nominal charge (maybe

$15 or less for a half hour) Of course when word gets out - at times

there is a waiting list for services - so it's worth checking out now!

US -great resource and easy to navigate:

http://facstaff.uww.edu/bradleys/cdprograms.html

Canada

http://www.caslpa.ca/english/connections/conn1.html

UK/Ireland

http://www.rcslt.org/courses.html

Europe

http://www1.ldc.lu.se/logopedi/europe/

In addition -sometimes there are organizations like the ELKS that

will sponsor children for subsidized therapy -ask around for that too

through child services, Easter Seals, or office of disablity (etc.)

in your

area.

If anyone has any other comprehensive lists they would like to share -

please do! Also a good list of oral based schools for the hearing

impaired which may be worth looking into for your apraxic child is

here: http://www.oraldeafed.org/schools/index.html

If you visit Speechville and put in your state for resources you can

find a list of Universities and so much more!

http://www.speechville.com/regional-resources.html

support groups

http://www.speechville.com/communication-station/regional-support-groups.html

I'm not

sure if you are in the US or not -but here in the US, once children

turn three, if they are qualified for special education, they are

eligable for FAPE -a free and appropriate education through the

school -which typcially early intervention professionals assist with

that transfer (a few links below). I'm not sure if it's too late to

get your child ESY (extended school year) services right now, but

other qualified preschool and school age children are recieving that

right now in your town. Either way -starting in the Fall, your

child if qualified should enter your town's preschool disabled

program -or whatever they call it where you live, where, if

appropriate, you can

advocate to have specific amounts of individual speech, PT or OT

therapy

sessions written into Grace's IEP. The squeek always

gets the grease though -so it appears you may have to push to

continue the therapy that's appropriate for your child. The school

is not required to provide the best therapy -just what is

appropriate. When it comes to school law -it's complicated

below are a few links

http://www.listen-up.org/rights2/osep7.htm

http://www.stnonline.com/stn/specialneeds/sn_federalaws.htm

http://12.46.245.173/cfda/cfda.html

When you seek out of district placement -the cool thing is that you

don't have to only search other school districts, you can also

search private schools. I have found over the years in this group

that many of us had the best experience and success with our children

with more severe speech impairments in schools for the hearing

impaired. Personally I prefer the oral based schools based on our

experience and those in this group with the Summit Speech School in

New Providence, NJ. Here's a list of some others

http://www.oraldeafed.org/schools/

http://www.oraldeafed.org/schools/index-list.html

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